How did Amy Metz die?

What happened to Amy Metz the Hampstead woman who was found in the snow on Jan. 24, 2016 near her home on Wellesley Court? Through a Public Information Act request, the Carroll County Times obtained the sheriff’s office investigation reports.

What happened to Amy Metz the Hampstead woman who was found in the snow on Jan. 24, 2016 near her home on Wellesley Court? Through a Public Information Act request, the Carroll County Times obtained the sheriff’s office investigation reports.

An autopsy was performed on Amy Metz on Jan. 25, 2016, by Dr. Meghan Kessler with the Office of the Chief Medical Examiner in Baltimore. The autopsy report lists the cause of death as undetermined. The manner of death also was listed as undetermined.

“Because it remains unclear whether Ms Metz’s death is the result of a cardiac arrhythmia [spontaneous interruption of the normal electrical rhythms of the heart] due to the multifactorial interaction of alcohol intoxication, hypothermia, and her underlying heart condition and/or the result of inflicted injury or a neglectful act, and in consideration that the circumstances of death remain unclear despite police investigation, the cause of death is best certified as Could Not Be Determined (Undetermined), and the manner of death is best certified as Could Not Be Determined (Undetermined) at this time,” according to the report.

Bruce Goldfarb, the spokesman for the medical examiner’s office, said the office could not comment specifically on Metz’s autopsy, but spoke to the Times generally about medical examinations.

Goldfarb said there are five categories that a manner of death can be classified: accidental, suicide, homicide, natural or undetermined. Medical examiners have to make the determination with a “reasonable degree of medical certainty,” Goldfarb said.

It’s not unusual for an autopsy report to list the manner of death as undetermined, Goldfarb said.

For example, according to the OCE’s 2014 annual report, 22 percent of autopsies that year returned a finding of undetermined.

Carroll County Sheriff’s Office Maj. Charles Rapp said that he has worked on investigations before in which the report lists the cause and manner of death as undetermined. Having it ruled undetermined in the Metz case didn’t hinder the investigation, Rapp said in an interview.

Injuries listed in the autopsy report included abrasions on the head and scalp, with hemorrhages, or bleeding, to the neck and scalp muscles, according to the report.

Metz had small abrasions on her forehead, cheeks and chin. She had small bleedsunder her scalp with hemorrhages from her deep neck muscles, according to the report.

She also had a small abrasion on her chest and little cuts on her hip, according to the report.

Rapp said the inflicted marks in the medical examiner’s report were consistent with information they gathered from the investigation. All the injuries to Metz occurred while she was alive, he said.

None of the injuries was significant enough to be the cause of death, Rapp said.

A pathologist who examined Amy Metz’s heart found evidence of cardiac disease, which, according to the report, “functioning alone or in combination with alcohol intoxication and hypothermia [exposure to the cold environment] can be responsible for a sudden cardiac death.”

Dr. Martha Gulati, a heart specialist who is the division chief of cardiology at University of Arizona’s College of Medicine, said that Metz likely had arrhythmogenic right ventricular dysplasia (ARVD), a cardiac disease that can cause sudden death, and is when normal heart tissue is replaced by fat. The Times contacted Gulati based on her expertise about heart disease and shared with her Metz’s autopsy results.

ARVD is a cardiac disease that appears in younger people, especially males, and athletes, Gulati said. It’s the disease that can come to mind when an athlete suddenly dies on the field.

According to Johns Hopkins Hospital’s website, ARVD, also known as arrhythmogenic right ventricular cardiomyopathy, accounts for one-fifth of the sudden cardiac deaths in people 35 and younger. It affects about one in 5,000 people.

Gulati said the pictures of Metz’s heart included in the autopsy report show fatty tissue in the right ventricle of the heart muscle, which is abnormal because the tissue there should just be muscle.

While the autopsy report stated that Metz did not have the fibrofatty replacement in the right ventricle, typical of ARVD, she had the right ventricular dilation, or a bigger right ventricle, and transmural fat infiltration, which are characteristics of the disease.

While it accounts for sudden cardiac death, the disease is not always fatal. People with the disease can pass out due to the disease and wake up. But in other cases they don’t. It is a disease without a lot of warning, Gulati siaid.

It’s also a genetic condition, meaning that children of people with ARVD have a 50-percent chance of inheriting it, Gulati said.

Metz was legally impaired at the time of her death, with her vitreous fluid showing the equivalent of a 0.29 blood-alcohol content and her femoral blood having the equivalent of a 0.25 BAC, according to the report. Under Maryland law, a person can be charged with driving under the influence per se if they operate a motor vehicle with a BAC of 0.08 or higher.

Seeing the undetermined manner and cause on the autopsy report was hard for the family, sister Susie Peters said.

“I think that’s where we’re really struggling,” she said. “After all this time and we get handed an undetermined.”

Editor’s note: An earlier version of this story incorrectly stated the BAC for which a person can be charged with DUI in Maryland. It has been updated to include accurate information.